Research and policy related to children has focused on expanding eligibility for public insurance programs, but expanding access to a system that does not deliver necessary services will not result in optimal outcomes. Deficits in care delivery must be identified if appropriate strategies to close the gaps are to be developed and implemented. Title IV of the Child Health Insurance Program Reauthorization Act (CHIPRA) called for the Secretary of the U.S. Department of Health and Human Services to identify and post for public comment an initial, recommended core set of children's health care quality measures for voluntary use by Medicaid and Children's Health Insurance Programs (CHIP). While this initial core set of measures represents a good starting place, it is just the first step in a long term process to develop a rigorous, standardized set of measures that will facilitate routine quality assessment and guidance on priorities for improving children's healthcare quality. Several deficits were identified during the selection of the initial core set of measures mandated by the CHIPRA legislation. These included a dearth of measures for particular types of care and care settings as well as an inability to adequately collect data on race, ethnicity, and special health care need status to monitor variations in care and disparities. Additionally, no quality measures were identified that assess most integrated health care settings. For this project we have assembled a Center of Excellence on Quality of Care Measures for Children with Complex Needs (COE4CCN). The COE4CCN brings together a diverse and talented group of organizations and individuals who have the expertise and capacity to rigorously develop and test quality measures that address all of the above mentioned areas of deficit. The COE4CCN includes experts in the areas of survey measure development, evidence-based process measure development using medical records and/or administrative data, risk adjustment, assessing disparities, and appropriately identifying and stratifying children with special health care needs into meaningful risk categories. Additionally, the COE4CCN brings together content experts in several key areas including the medical home, caring for CSHCN, child and adolescent mental and behavioral health, chronic disease management in adolescents, racial/ethnic disparities, and health informatics. Several key stakeholder groups will also be integral members of the COE4CCN, including representatives from Medicaid and CHIP programs in two states (WA and MN), representatives from the AAP Chapters in WA and MN, and representatives from MN Family Voices. The COE4CCN will have the ability to develop meaningful, rigorously designed, disseminable quality measures that can be used at the national level to both track and improve on the quality of care provided to US children. PUBLIC HEALTH RELEVANCE: The quality of care measures we propose to develop under this award will provide new tools to rigorously and comprehensively evaluate health care for children with complex needs. Without such measurement tools, it is not possible to assess where deficits exist and how to target efforts to best improve care. These measures will be designed for dissemination and use among all Medicaid and Child Health Insurance Programs (CHIP) nationally.